RCM (Revenue Cycle Management)

Medical Coding

Having an experienced AAPC Certified Medical Coding Team for Coding and Audits ….

Having an experienced AAPC Certified Medical Coding Team for Coding and Audits …. Revolent healthcare solutions is one of the best leading coding company. Revolent healthcare solutions is well aware about the importance of Medical Coding in RCM system and for submission of clean claims. Accurate Medical Coding will help in reduced denials and also a fast flow of revenue for our clients.

Medical Coding is one of the main reason for Denials. So as understanding the importance of Medical Coding and to reduce the coding errors in starting itself we have AAPC (American Academy of Professional Coders) certified medical coders, to maintain the highest level of accuracy and quality of work. Revolent healthcare solutions believes in meeting and exceeding the industry standards without compromising on quality for our clients.

We have ICD-9-CM, CPT-4, HCPCS coding, ICD-10-CM and ICD-10-AM medical coding experienced staff.

• Chart Audits and Code Reviews
• Offshore coding audits
• Payer specific coding requirements

Our Coding team accomplishes Medical coding process with perfection to ensure error free claim submission to insurance carriers. A separate sub group of experienced coders handles the HCC medical coding and their audits. A separate audit team audits all the coding done before the claims are processed.

We conduct professional; trainings for our coding team to make them aware about the latest changes and updates in the process.

Medical Billing

Charges Entry and Claims

This is one of the most important process of Revenue Cycle Management. It includes Demographic Entry, creating patient accounts and assigning the appropriate charge amount for billing as per coding and insurance fee schedule. This process ensures the reimbursements to the provider as per services rendered, so any error in this process can lead to denial or delay in reimbursement, even less reimbursements as well. To to avoid all these denials and delay in reimbursements a clean claim submission is important in first time. So a good co-ordination in required between coding and charges entry team for clean claim submission and enhanced results.

Revolent healthcare solutions have experienced charge entry team which provides 99% accuracy in charge entry and claim submissions. Which leads to a timely flow of revenue and less denials. This leads to a continuous flow of revenue to our clients and helps them to focus on their business instead of revenues and other billing issues.

Charges Entry Process at Revolent healthcare solutions

• Charge entry process is done account wise as per client specifications in clients medical billing software.
• Charges having issues and need clarification are sent to client on timely manner to clarify the issues and for quick billing.
• The final charges are audited by the experienced audit team before submission to avoid any errors and for maximum clean claim submissions.

Account Receivables Follow Up

Days in AR is the average number of days it takes to collect the payments due to your practice. It may vary amongst insurers. Medicare usually takes about 14 days to pay after receiving a claim while some HMOs may even take up to 45 days to pay after claim receipt as this much time is allowed by law in some states.

Days in AR” is the first measure of the overall performance of your accounts receivable efforts. The following figures are looked as benchmarks for medical billing and collections:

• 30 days or less for a High performing Medical Billing Department.
• 40-50 days for an Average performing Medical Billing Department.
• 60 days or more for a Below Average Medical Billing Department.

AR follow up ensures that healthcare organizations have a way to recover overdue payments and includes looking after denied claims, exploring partial payments and reopening claims to receive maximum reimbursement from the insurance companies.

At Revolent Healthcare Solutions,

• Our team well experienced in AR follow up, prioritizes the workflow in 2 different categories i.e. Potential collectible & Non Collectible to ensure you don’t lose money by not following up on potential collectable accounts, also creating appeals & providing Medical Records if and when required.
• Our AR follow up team is extremely proactive in identifying issues that interrupt critical revenue procedures by constantly communicating with the patients, insurance firms, and healthcare service providers and taking necessary actions based-on their responses or feedback.
• Our AR experts do a thorough research of each account. They analyze and formulate the right follow up strategy to get to the core of the problem.
• Our AR analysis team studies all insurance claims as well as unfinished payments in detail including the insurance contracts, execute collection analysis, bad debt reviews, and ratio analysis to ensure that your practice is reimbursed correctly.
• Our team comprises of experienced and skilled health care professionals who ensure cross functional collaboration to ascertain correct and complete data entry and accurate medical coding which is usually the main reason for denial.
• We provide daily/weekly reports to customers about the progress of payments and recommend adjustments which may be needed.
• We provide AR follow up for old (>180 days) accounts as well as new ones.

How outsourcing these services to us benefits you?

• Recover overdue payments by services to track old ARs also and streamline your AR process.
• Quick and efficient services at highly cost-effective rates and cuts down the cost of infrastructure and manpower needed at your end.
• We are 100% HIPAA complaint and have robust intrusion prevention service with fully managed firewall solutions and encrypted virtual private network.
• Immediate resolution of denied claims and refiling recoverable claims.

Patient Services

Patient Collection term includes the patient balances or the patient account receivables. This is the provider balance pending with the patients, which are their clients as well. So for such kind of collections a very efficient and trained team is required for follow up with patients. Also a monthly statements need to generate and to mail it to patients at their address. Revolent healthcare solutions have a very experienced team to handle patient AR and proficient in soft collections calls. Also very good in monthly statement generation and to mail them after auditing, as only actual balance should go to the patient. All Revolent healthcare solutions have experienced staff to handle patient’s incoming query calls and the payments they want to make on call. We assure our clients for a quality work in patient collections domain.

Provider Credentialing

Provider credentialing is the important part for any provider as to get paid provider need to be credentialed with the payers. If provider is not credentialed, he will not get paid by insurances. Revolent healthcare solutions have experienced staff to help new providers in credentialing. Credentialing team have good experience in new provider credentialing and also in resolving old credentialing issues.

PAYMENT POSTING SERVICES

Revolent Healthcare Solutions payment posting services enhances processing accuracy and effectiveness in revenue collection.

We have in-depth expertise in each step of the RCM workflow. To offer customized services to our clients, we offer each step in RCM workflow as a separate service that can be leveraged by merging into the existing process of the provider.

An optimized and high precision posting system is as crucial as the documentation and coding in the RCM workflow. Many healthcare providers are often not able to fully tap the potential of this step which adversely impacts their revenue.

As industry experts, we have extensive experience and proven strategies to leverage the effectiveness of payment posting in escalating the revenues.

As a leading data analytics expert with advanced digital platforms, we are competent to study the payment cycle, trends and provide insights on your denials and payments. Healthcare providers should look at it as a comprehensive way to streamline their collection process.

While all major healthcare providers aim towards clean and accurate claim submissions, many of them fall short due to inaccuracy in payment posting.

Our effective payment posting service can add value to your RCM workflow. It not just keeps your in-house staff hassle-free but also aims at attaining higher accuracy.

Payment Posting Services for Enhanced Effectiveness

Payment posting is the final step in the billing cycle. Complete records are loaded in the billing software and it is ready for the next step in the RCM cycle. Our payment posting team optimize your RCM cycle by accurate posting and reconciliation at the end of every month. Effective posting can go a long way in increased revenue. They also renders meaningful insights into improving predecessor steps in the RCM workflow. You can be benefited from one or all of our below-mentioned services:

• Explanation of Benefits (EOBs) Analysis
• Tasks Based on EOB Analysis
• Tracking Cash Inflow

Explanation of Benefits (EOBs) Analysis

As large volumes of payment postings are done on an everyday basis, there is a need for analysis as per the parameters required in this step. The information being entered is name, service date, account numbers, codes, confirmation, denials, and insurance-related information. Our team is competent not just in entering data but also derive meaningful analysis on the receivables, the frequency of inflow, any denials or remittances.

Tasks Based on EOB Analysis

Once data is accurately recorded, we are capable of extracting analysis and charting the patterns. This study of payment receivables helps us in devising an action plan to the billing department. Patients are followed up on balance payments and acts as a support action for collections. Outstanding payments are often large sums of money and they have a valuable role to play in your revenue stream.

Tracking Cash Inflow

A real-time dashboard for outstanding receivables and cash flow analysis is pivotal in managing the financial feasibility of the business. It gives an indication when payment follow-up is delayed and requires prompt action.

Payment Posting also required remittance transactions with precision. Revolent Healthcare solutions can be your collaborative partner in the following remittance procedures:

• Electronic Remittance Advisory (ERA) Posting
• Manual Payment Posting
• Denial Posting
Let’s have a detailed look at how each of these procedures functions.

Electronic Remittance Advisory (ERA) Posting

Generally useful for high volume transactions, this method involves uploading of files on the system. Certain files get rejected and after corrections, they are again uploaded in the system. It is time-saving and has great functionality for big healthcare units.

Manual Payment Posting

EOB documents are scanned and posted and information is recorded on each patient account. This requires more precision within the team to ensure accuracy is maintained.

Denial Posting

You require proficient and trained professionals to understand the ANSI denial codes. The remark codes are also crucial and staff must be fully aware of the codes used by different insurance companies. We post the denials appropriately and take the required action such as transferring the balance to the patient account or send billing information to the secondary payer or make adjustments. It is important that any denied claim is appropriately routed and healthcare units can benefit from our expertise in this function.

Technology Led Payment Posting Tools by Revolent Healthcare solutions

As a comprehensive professional in the RCM services, we have devised cutting edge technology to improvise each step in the process. Payment Posting is one such task that is powered with crucial platforms that make it accurate and directed towards better accounts receivables.

Payment Posting is not just a Procedure, it is a Business Strategy

Healthcare professionals view payment posting as a function but we envision it as a business strategy to step up on our overall RCM workflow. This step renders important insights on shortcomings and helps us develop ahead. Revolent Healthcare solutions has developed systems using the data insights of payment posting. It has been a value-adding business move for all our clients.

1. Analytics

Data analysis is the basis of all wisdom in any business function. A dashboard shows you real-time information and a detailed analysis of trends in denials, errors, non-covered claims, and general collection problems may be helpful in combating these issues.

2. Develop Policies & Procedures

Real business scenario needs to be adjusted as per the situational analysis. We may help you revisit your policies for adjustments and write-offs more effectively. We can help you make some modifications that help you maximize your cash flow with less effort.

How Revolent Healthcare solutions can be your value adding partner in payment posting

With over a decade of experience, we have worked across different service providers and dealt with a multitude of insurance companies. We are able to customize our services and weave it into your existing system with efficiency. Accuracy and reliability are our benchmarks while dealing with payment posting.

It is a competitive blend of process optimization and technological intervention that makes us a preferred service provider. We position ourselves not just a service provider but as a center of excellence in helping you grow your business based on your objectives.